Complications and Functional Results of Surgery for Locally Advanced Prostate Cancer

The role of surgery in clinical stage T3 prostate cancer (cT3 PCa) is still subject to debate. We reviewed the records of 139 consecutive patients who underwent a radical prostatectomy (RP) for cT3 PCa with a mean follow-up of 8 years. All data related to surgical and perioperative complications were collected. Continence and erectile function were assessed at 12 months postoperatively and long-term oncologic outcomes were analyzed. Rectal injury and injury of the obturator nerve occurred both in 0.7% of cases. No serious in-hospital complications were noted and no reintervention was needed. Lymphatic leakage was noted in 2.2% of patients and 1.4% experienced prolonged drainage of urine. In 7.2%, wound-related problems occurred. Anastomotic stricture occurred in 2.9%. These complication rates were not different compared to surgical series of RP in localized PCa. At 12 months, complete continence was 87.8% and erectile function had fully recovered in 6% and 10% of patients who underwent a non-nerve sparing or unilateral nerve-sparing procedure, respectively. 10-year estimated biochemical PFS, clinical PFS, CSS and OS were 51.8%, 85.6%, 94.6% and 85.9%, respectively. In cT3 PCa, RP is technically feasible with morbidity comparable to RP in clinically localized PCa. Long-term oncologic control was excellent

Treatment of chronic low back pain in patients with spinal deformities using a sagittal re-alignment brace

<p>Abstract</p> <p>Background</p> <p>For adult scoliosis patients with chronic low back pain bracing is initially indicated before spinal surgery is considered. Until recently there has been a lack of research into the effect upon pain reductions in the mid and long-term. Promising results have been documented in short-term studies for the application of a sagittal re-alignment brace in patients with spinal deformities and along with pain; however mid-term and long-term results are not yet available. The purpose of this study is to investigate the mid-term effects of this brace with respect to pain control.</p> <p>Materials and methods</p> <p>67 patients (58 females and 9 males) with chronic low back pain (> 24 months) and the diagnosis of scoliosis or hyperkyphosis were treated with a sagittal re-alignment brace (physio-logic brace™) between January 2006 and July 2007. The indication for this kind of brace treatment was derived from a positive sagittal re-alignment test (SRT) and the exclusion of successful conservative treatment during the last 24 months. The aim of this type of conservative intervention was to avoid surgery for chronic low back pain.</p> <p>Results</p> <p>The average pain intensity was measured on the Roland and Morris VRS (5 steps) before treatment. This was 3.3 (t1), at the time of brace adjustment it was 2.7 (t2) and after at an average observation time of 18 months it was 2.0 (t3). The differences were highly significant in the Wilcoxon test.</p> <p>Discussion</p> <p>Short-term measurements showed that a significant pain reduction is possible in chronic postural low back pain using a sagittal re-alignment brace inducing lumbar re-lordosation. In a preliminary report at adjustment (t2), highly significant improvements of pain intensity have also been demonstrated. At 6 months of treatment however, no improvement was measured. The improvement of the mid-term effects (18 months) found in this study compared to the preliminary report may be due to the changed approach to compliance: whilst the bracing standard was not changed; the patients in this study were obligated to wear the brace for a minimum of 20 hrs per day for the first 6 months of treatment.</p> <p>Conclusion</p> <p>The effect of the sagittal re-alignment brace leads to promising short-term improvements in patients with chronic low back pain and spinal deformities. Contrary to unspecific orthoses, which after a short period without persistent pain reduction are omitted by the patients, the sagittal re-alignment brace (physio-logic™ brace) leads to an effective reduction of pain intensity in mid-term even in patients who have stopped brace treatment after the initial 6 months of treatment. In conservative treatment of chronic low back pain specific approaches such as the sagittal re-alignment brace are indicated prior to considering the surgical options.</p

Changing current practice in urology: Improving guideline development and implementation through stakeholder engagement

Effective stakeholder integration for guideline development should improve outcomes and adherence to clinical practice guidelines

Infant mortality in mid-19th century Amsterdam:Religion, social class, and space

This study uses a unique historical GIS dataset compiled from birth, death, and population register records for infants born in the city of Amsterdam in 1851 linked to micro‐level spatial data on housing, infrastructure, and health care. Cox's proportional hazards models and the concept of egocentric neighbourhoods were used to analyse the effects of various sociodemographic characteristics, residential environment, water supply, and health‐care variables on infant mortality and stillbirth. The analyses confirm the favourable position of the Jewish population with respect to infant mortality as found in other studies and show the unfavourable position of orthodox Protestant minorities. Infant mortality rate differences are much smaller between social classes than between religions. The exact role of housing and neighbourhood conditions vis‐a‐vis infant mortality is still unclear; however, we ascertained that effects of environmental conditions are more pronounced in later stages of infancy and less important in the early stages of infancy

IMAGINE-IMpact Assessment of Guidelines Implementation and Education : The Next Frontier for Harmonising Urological Practice Across Europe by Improving Adherence to Guidelines

Funding support: The IMAGINE ADT audit is supported by a seeding grant from the EAU Research Foundation.Peer reviewedPostprin

Application of the Occupational Sitting and Physical Activity Questionnaire (OSPAQ) to office based workers

Background The workplace is a setting where sedentary behaviour is highly prevalent. Accurately measuring physical activity and sedentary behaviour is crucial to assess the impact of behavioural change interventions. This study aimed to evaluate the reliability and criterion validity of the Occupational Sitting and Physical Activity Questionnaire (OSPAQ) and compare with data collected by accelerometers. Methods A test-retest study was undertaken on 99 participants using the OSPAQ. Data were then compared to accelerometer records of 41 participants. Reliability was assessed by paired t-test and intra-class correlations (ICC) via a two-way mixed model based on absolute agreement. Difference and agreement were measured by comparison of mean self-reported data with accelerometer data using the Pearson’s correlation coefficient and Bland-Altman plots. Results The ICCs for minutes spent sitting (0.66), standing (0.83) and walking (0.77) showed moderate to strong test-retest reliability. No significant differences were found between the repeated measurements taken seven days apart. Correlations with the accelerometer readings were moderate. The Bland-Altman plots showed moderate agreement for standing time and walking time but systematic variation for sedentary time. Conclusion The OSPAQ appears to have acceptable reliability and validity measurement properties for application in the office workplace setting

Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial

BACKGROUND: Large-scale RCTs comparing different types of exercise training in institutionalised older people are scarce, especially regarding effects on habitual physical activity and constipation. This study investigated the effects of different training protocols on habitual physical activity and constipation of older adults living in long-term care facilities. METHODS: A randomized controlled trial with 157 participants, aged 64 to 94 years, who were randomly assigned to 1) resistance training; 2) all-round functional-skills training; 3) both; or 4) an 'educational' control condition. Habitual physical activity was assessed with a physical activity questionnaire and accelerometers. Constipation was assessed by a questionnaire. Measurements were performed at baseline and after six months of training. RESULTS: At baseline the median time spent sitting was 8.2 hr/d, the median time spent on activity of at least moderate intensity was 32 min/d. At baseline, about 22% of the subjects were diagnosed with constipation and 23% were taking laxatives. There were no between-group differences for changes in habitual physical activity or constipation over 6-months. CONCLUSION: Six months of moderate intensity exercise training neither enhances habitual physical activity nor affects complaints of constipation among older people living in long-term care facilities